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Fault Lines: Infertility and Imperiled Sisterhood

As a feminist and as a nurse who has cared primarily for women and whose research now addresses their concerns, I am increasingly aware of my in-betweenness. Nurses are in-between physicians and their patients, morally and/or legally obliged to serve the interests of both parties, and they are in-between feminists and women patients, enjoined to realize feminist, nursing, and their patients’ visions of good healthcare. The nurse’s vantage point of in-betweenness and her position on the front lines of providing effective and compassionate care for women has allowed me to see the problems infertile women and feminism pose for each other.

I have spent the last several years researching the lived experience of infertile women and couples and read widely in scholarly, personal, and imaginative literature on infertility. I have repeatedly encountered the theme of imperiled sisterhood in my interviews with infertile women 1 and in women’s autobiographical accounts of and fiction about infertility.

In the first part of this essay, I describe and illustrate the imperilment of bonds among contemporary women as a result of the experience and social construction of infertility. I interweave with published accounts of and fiction about infertility the oral testimony of the respondents in my studies. Although I recognize that fiction is not in the same domain of truth as the actual experiences documented in interviews and memoirs, it has validated, illuminated, and articulated with particular force the experiences my respondents shared with me. Fiction also helped to expose some of the contradictions in feminist theorizing about infertility and reproductive technology. In the second part of this paper, I argue that many current feminist critiques of reproductive technology perpetuate and intensify the tensions that already exist between fertile and infertile women and reinforce, rather than counter, patriarchal ideas about and divisions among women.

Neither Mother nor Sister

A major concern in current feminist scholarship about advancements in reproductive technology, particularly techniques intended to enhance fertility and bypass infertility, is the gradual “deconstruction of motherhood” as a “unified biological process.” Instead of “mother,” there are genetic mothers, birth mothers, adoptive mothers, surrogate mothers, and other fragmented maternities created by male concepts of parenthood and implemented by techniques such as in vitro fertilization and embryo transfer. Technologies intended for procreation, to diagnose aberrant fetal conditions, and to control childbirth are implicated in the undermining of women’s biological claims to maternity and reproduction, alienating them from their bodies and their babies.

Yet, there is at least one other equally important deconstruction occurring, namely, that of female friendships or of sisterhood. The idea of sisterhood suggests women’s recognition of a “shared experience that has been mystified and obscured” under conditions of male domination. In recent years, we have acknowledged the strains on sisterhood imposed by differences in race, age, sexuality, and class. Labels such as “mother” and “infertile woman,” in addition to describing women, also prescribe certain patriarchal standards and expectations for women that defy female unity.

We live in a cultural milieu that promotes motherhood and subverts sisterhood. Yet however influenced by the patriarchal language and expectations of our culture, infertile women experience their “difference” as a source of real anguish. For the woman trying unsuccessfully to have a child of her own, there are “two classes” of women, the fertile and the infertile. There are the women who conceive much too easily and then “abort and put `em in plastic bags”; and there are the women who would, if only effort, planning, and desire for children always resulted in maternity, be “good mothers.” There are the women who “take drugs and eat clay and have normal babies,” and there are the women who do everything in their power to have any baby at all and still unaccountably fail. For many women trying to have children of their own, there is no recognition of female experience shared with women who have babies by “accident” or who abort them; these women are diametrically opposed. The involuntarily childless woman experiences no commonality with the involuntary mother.

Infertile women feel thwarted in their efforts to enter the female world and to exchange in the “currency of women.” They feel “lost out,” marooned, and separated from their obviously fertile mothers, sisters, and sisters-in-law. One respondent observed that it was hard to talk even to her mother because she had experienced five normal healthy pregnancies. Another woman remarked that she was neither a good nor a desirable daughter-in-law because of her failure to reproduce. Yet another respondent bitterly noted how close she had been to her sisters-in-law before their children arrived and how, after nine years of involuntary childlessness, a chasm developed between them.

Infertile women are alienated not only from the pregnant women and mothers who are, by the “twisted priorities of fate,” the least prepared and the least desirous of maternity, but also from the women who appear (to the sensitivities of infertile women) to flaunt their pregnancies, “rubbing it in” while rubbing their bellies. Infertile women experience a profound sense of Otherness, of being neither female nor male, infused with feelings of fascination, envy, persecution, and even rage. Fertile and infertile women are enmeshed in a conflict that reflects the patriarchal devaluation of both mothers and childless women, “safe and visible objects of discontent” for each other.

Contemporary women’s literature contains several powerful accounts of the tormented feelings of infertile women, accounts consistent with the experiences of the infertile women in my studies. Liz, the central character in Sara Maitland’s novel about infertility, The Languages of Love, feels as distant from women as from men. Each belongs to an “elite society of their own…two powers, and she could partake of neither.” “When she saw women in cotton pinafores, with stretched jerseys underneath, who walked the unmistakable walk of pregnant women, who shifted themselves with their hands laid tenderly either side of the swelling…she felt jealous, a stabbing anger and pain that she had never felt for a man.”

shriek to each other across their prams. Joggle their dummy-stuffed spoils of the sex war up and down. Trundle along with their suburban bellies bloated with the booty of the bed. “How far are you on, then Doreen? Five months? Oh, I’m six.” Cows. The only function they’re up to, so they crack it high: cows, cows. They look at me. “You haven’t pillaged your breadwinner’s basket in the dark when he thinks he’s polishing the top sheet with his arse; you haven’t ignited a brat; you’re no woman, you’re inadequate.”

She began to hate every woman she knew who had a child. In department stores, in grocery stores, she would see a woman with a baby in a cart or in her arms and she would be filled with such anger, such hatred, that she would have to leave the store, leave her cart full of groceries, or risk hitting the woman—it was that bad, her fists would clench and she would want to hit, to hurt any woman who had a baby.

Recurring scenes of female culture illuminate the estrangement of infertile from fertile and even from other infertile women. One of the most vivid and iterative of these scenes in both the oral testimony of my respondents and in fictional accounts is the baby shower. The baby shower is the female ceremony from which infertile women feel most excluded, because of their inability to reproduce, but in which they feel compelled to participate, because they are female and in relationships with sisters, sisters-in-law, and friends.

In Mary Martin Mason’s short story, “The Baby Shower,” a mother forces her infertile daughter to attend her sister’s shower. There is already “a rift the size of the San Andreas Fault” between mother and daughter because DES has made the daughter sterile. The mother is guilty, the daughter is resentful, and each woman is “claim[ing] her share of the pain.” At the shower, the daughter meets another woman who is also childless and forced to attend the shower. While the other women engage in the baby shower rituals, these two women share their mutual feelings of exclusion and hostility. My respondents described similar feelings of coercion in maintaining a facade of cheer for other women’s pregnancies and guilt over the feelings of envy and rage that lay behind the facade. One of my informants explained that being around pregnant women was akin to having a “candy bar” placed in front of you that you could not have.

Another evocative scene of female estrangement is the physician’s waiting room where covert appraisal, ambivalence, and anger characterize the infertile woman’s “waiting,” not only for the physician but also for a pregnancy. Women may not talk to each other in the exposed and tense environment of the waiting room but rather covertly check each other out for signs of infertility and for signs of pregnancy. In Sheila Ballantyne’s novel, Norma Jean the Termite Queen, the physician’s waiting room is “a gigantic womb, filled with the imagery of reproduction” and one of the quintessential states of the female is “waiting to get.” For one of my respondents, eager for pregnancy, the wallpaper in the waiting room evoked images of eggs and sperm swimming and uniting. Joyce Bichler, a DES daughter who was forced to undergo a hysterectomy and vaginectomy for cancer, recalls in her memoir how “vulnerable” she was in the physician’s office where she “would sit and stare at all the pregnant women…and alternate between being fascinated by them and angry at them.” Margaret Atwood’s fictional handmaids in The Handmaid’s Tale, whose social status is dependent on their ability to reproduce, “covertly…regard each other [in the waiting room], sizing up each other’s bellies: is anyone lucky?” The waiting room in Maitland’s novel, The Languages of Love, is the scene of both joy and despair. While Liz, who is trying desperately to become pregnant, waits in the physician’s office, a woman comes out “laughing and crying” that she is pregnant. Liz recalls “There was a sudden silence in the waiting-room. There must have been six women there and they were all completely silent. The ecstatic woman looked around, realised what she had done, and had begun to blush. `I’m sorry, I’m sorry, I didn’t think, I just wanted to tell the world.’“ Another woman waiting with Liz stiffly congratulates her, and Liz manages to do the same. “But she could hardly get the words out; the woman next to her began to cry and Liz knelt down and took her hand. She felt overwhelmed by shared tenderness, she was crying herself.”

One of my respondents described how she and other women would check each other out in the waiting room to determine the “type” of woman who would have a fertility problem. She had disassociated herself there from the “fragile little girls” who needed help conceiving.

As the passage from Maitland’s novel and the oral testimony of my respondents suggest, there is a “sisterhood” or special “bond” infertile women share with each other, yet their bond is threatened by competition and jealousy and by the fact that, by itself, the inability to have a desired child is a weak foundation for a lasting relationship. In a pronatalist milieu, infertility can forge an unwilling sisterhood, a tenuous bond among involuntary inhabitants of the deviant subculture of childless women. All too often in my respondents’ experiences, friendships disintegrated and infertility support groups dissolved as women who achieved pregnancy (even when these pregnancies resulted in miscarriage) became objects of resentment, like thin people in “a Weight Watcher’s group.” Women sometimes covertly competed with each other over whose circumstances were more deserving of recognition and over whose infertility problem was really worse. Jacquelyn Mitchard, who was accused by her husband of regarding every woman’s happiness in pregnancy as a personal assault, recalled thinking that if fewer women knew of the new in vitro fertilization service she had recently discovered, she would have a better chance of being accepted into the program.

Images of sisterhood subverted are particularly vivid in Fay Zachary’s novel, Fertility Rights, in which infertility and maternity are the experiences that motivate women to fight and deceive each other, to kidnap each others’ children, and even to murder each other. In this extreme and nightmarish inversion of reality in which women are the dominant and principal actors, more powerful than men, fertile and infertile women, genetic and surrogate mothers, and midwives and childbearing women engage in the most sinister kinds of struggles for babies and the power babies offer women. Suspicion, envy, and hatred among women are the driving forces. Although a male physician invents the artificial means of reproduction that becomes a basis for the disputes among women, it is a female nurse who uses these means to realize her vision of the eugenically perfect society. No man is overtly needed here to subjugate women; they do it themselves. The proximate agents of pain and of control of women are women themselves.

The Problem that Has No Answer

Infertility presents a problem for which “there doesn’t seem to be a nice feminist answer.” The technological solutions to infertility challenge feminist thinking because they offer new options to women at the same time that they threaten women’s reproductive freedom. Infertility itself also surfaces the limitations that biology places on women’s ability to pursue life options in addition to maternity. Ironically, some feminist critics of the new reproductive technologies have inadvertently forged an uneasy partnership with manifestly antifeminist critics in their concerns about infertile women’s demands for these technologies in order to have children of their own.

Current feminist discourse has largely focused on the consequences of using technologies developed to remedy infertility, rather than on the infertility experience itself. Infertility did not become an issue for feminists until the advent of in vitro fertilization and other sensationalized technological solutions to infertility. Recent feminist writing has emphasized the continuing medicalization of childbearing and motherhood and the male expropriation of reproductive power from women, furthering female subordination. Reproductive technologies are tied to patriarchal concepts of womanhood, parenthood, and family, making their further development and use unjustifiable in terms of the potential consequences for women as a social group, despite the promise they might hold for some individual women.

Infertile women find themselves confronted with a group of feminists who suspect their motivations to procreate as strongly as they suspect the medical community’s desire to create babies by artificial means; who exploit infertile women’s “desperation” to have children to affirm women’s oppression in the same way that some physicians exploit it to legitimate the further advancement of artificial means of reproduction; and who attribute to infertile women and couples the racism, classism, intolerance of imperfection, and the commodification of babies and of women that afflicts us all regardless of our fertility. Infertile women are already subject to considerable scrutiny regarding their motivations to have a child. Such scrutiny is an integral and painful part of infertile women’s efforts to be accepted as candidates for medical treatment (and for adoption). Although these feminist writers certainly acknowledge the suffering of infertile women, there is little in their discussions about reproductive technology or infertility that suggests real empathy with infertile women. There is little understanding that, for these women, infertility is a painful fact of their existence and not just a socially constructed or culturally prescribed reality. As Alison Solomon insightfully observed, feminists frequently fail to differentiate between the suffering caused by infertility itself and that engendered by medical treatment of infertility. Moreover, by reemphasizing the mother-child bond either as the prototype for bonds among women or motherhood “as an ascriptive status, as a taken-for-granted aspect of women’s lives,” some feminist scholars are themselves perpetuating the motherhood mandate they view as the basis for infertile women’s overly obsessive drive to reproduce by any means.

Several themes in current feminist discussions about advancements in reproductive technology are particularly problematic for infertile women. First, such discussions often miscontrue the infertile woman’s desire to have a child and her choice to seek technological assistance toward that end. The infertile woman is too often depicted as the unwitting victim of a pronatalist environment mandating motherhood for all married women and as the dupe of patriarchal efforts to disable women as a group. Because they do not recognize these imperatives as the basis for their desperate efforts to become mothers, infertile women are viewed as neither authentically wanting nor freely choosing medical/technological assistance to reproduce. Because most feminist thought denies the existence of a maternal instinct or innate drive to reproduce, the infertile woman’s will to reproduce becomes conversely nothing more than patriarchy’s mandate that she reproduce. Feminist discourse that emphasizes the lack of authentic desire in women, or that allows women no free will beyond the will inculcated by patriarchal culture, itself permits women no volition, no agency at all. Juliette Zipper and Selma Sevenhuijsen observed that

by denying the existence of any free will … the question of what is being oppressed in women’s oppression can only be answered by referring to a hypothetical Woman or Femaleness…. We have to accept will and longings as given. There is a difference between individual choices of women and political strategies of feminism…. It is a mistaken interpretation of the slogan “the personal is political” to deny women these choices and decisions and to develop a feminist morality about the rights and wrongs of life-styles. We have to develop concepts that do not subsume individual women under a supposed collectivity of women.

When some feminist critics suggest that women’s motivations for bearing children or their inclinations toward medically prescribed diagnostic and treatment regimens are spurious, or largely products of the social or gendered construction of choices, they are, in effect, dismissing and trivializing women’s desires. Curiously, the authors of the prologue to Made to Order complain that women such as themselves are often accused of having no independent judgments, of deriving their positions solely from those of men. Yet, they, in effect (if not by intention), charge infertile women with the same lack of independent judgment. They and other critics of conceptive techniques do not allow that female desire can be anything other than a response to or a reflection of masculinist ideology and socialization. As Rosalind Pollack Petchesky noted, “the fact that individuals themselves do not determine the social framework in which they act does not nullify their choices nor their moral capacity to make them.” Moreover, who really benefits from any “argument based on presumed incapacity of women to make decisions?” Is not the feminist agenda to counter such ideas about women?

Sometimes, the inversion of infertile women’s desires and choices is unnecessarily cruel. In her defense of Mary Beth Whitehead, Phyllis Chesler suggests that infertile (and fertile) couples now often desire children as objects to dominate and as “’life-style’ commodit[ies] to be acquired.” Sultana Kamal actually indicts those who desire to have a child through technological means. She remarks:

The enthusiasm of the commercial producers of these technologies is fanned by the attitude of certain people of not accepting the condition of “not having” anything. If it is a question of relationships, are there not different ways to relate oneself other than to one’s own children? Does not this obsessive craving to have a child of one’s own in many cases stem from an individual’s sense of private property or the desire to have somebody around over whom one has substantial control for some years at least? … Is not this craving more created than natural?

In an important way, the “obsessed” and “desperate” infertile woman and her determined efforts to have a child have become useful to those feminists who wish to illustrate the extent of female oppression, exploitation, and lack of freedom. The infertile woman’s tenacity becomes the sign of the perversity of women’s socialization.

Second, feminist discourse sometimes makes un unjustifiable juxtaposition between the “privileged infertile” woman, the woman willing and able to pay for the new conceptive techniques, with the socioeconomically disadvantaged woman, either fertile or infertile, denied access to even minimal health services. The infertile woman, whose independent choice of and informed consent for technological solutions to her infertility are often denied in critical feminist discourse is additionally depicted as choosing against other women when she pursues such options as in vitro fertilization. Some feminist critics contend that “the desire of some individual women to `choose’ this technology places women as a group at risk” and that the choices available to a few “are firmly based upon the lack of choices for others.” Those women denied access to this technology because they are too poor, or deemed too deviant, or unfit for parenthood; the profound injustices in healthcare delivery in the United States and elsewhere; and the compulsory sterilization of certain groups of women are called up to affirm the dubious morality of the privileged infertile woman’s choice. Ruth Hubbard, a prominent opponent of the continued development and use of new conceptive technology, remarks that in India:

where many children are dying from the effects of malnutrition and poor people have been forcibly sterilized, expensive technologies are being pioneered to enable a relatively small number of well-to-do people to have their own babies. In the United States, as well, many people have less-than-adequate access to such essential health resources as decent jobs, food and housing, and medical care when they need it. And here, too, poor women have been and are still being forcibly sterilized and otherwise coerced into not having babies, while women who can pay high prices will become guinea pigs in the risky technology of in vitro fertilization.

More recently, the plight of relinquishing mothers, coerced to surrender their babies at birth, has been cited to affirm the infertile woman’s and couple’s loss of “moral bearings” in their anything-goes pursuit of a child. Infertile women are viewed as benefiting from other women’s tragedies. Infertile women’s choices are viewed as causing or contributing to an array of injustices against other women whose anguish is found more deserving of feminist outrage.

Contending that they are “for” infertile women and not against them, these critics, by these very comparisons, are pitting one group of women against the other. Clearly, when compared to the suffering of women living in desperate life-and-death circumstances, the anguish of the infertile woman, especially the one who has everything but the child she wants, can hardly engender much sympathy. Yet, those who make such reductionist and overly simplistic juxtapositions have failed to show how one woman’s choice of in vitro fertilization denies anything to another woman. How exactly, as some feminist critics suggest, does the choice of a few privileged women disadvantage all women or compel the least privileged to pay for, or to be exploited by, the most privileged? Why would one woman have to accept sterilization because another woman elected to have a child by technological means? These juxtapositions locate the pervasively inequitable distribution of resources in the choices of the very few individuals who actually turn to infertility solutions, such as in vitro fertilization, instead of in the array of complex forces that operate against distributive justice. These comparisons are as invidious and divisive as the one antifeminists make when they connect one woman’s choice to abort with another woman’s inability to adopt as cause and consequence, and they reflect a distorted consequentialist logic.

Third, some feminist critics have placed infertile women in a paradoxical moral position. They charge infertile women with choosing against their sisters, albeit out of desperation and because they are lacking a feminist consciousness, but they are simultaneously enjoined to serve as moral exemplars of a feminist utopia in which sexism, classism, racism, the commodification of babies and of women, the lack of regard for children, and other social injustices do not exist. Feminists are concerned that infertile women prefer to beget and bear healthy children of their own, a desire that is virtually universal among women wanting children. They are concerned that white, infertile women prefer to adopt white children; that they prefer infants to older children; and that they want healthy children, rather than physically, mentally, or emotionally impaired children.

Infertile women’s desire for what most other fertile women want and have is questioned and is interpreted as racist, eugenic, and selfish. Infertile women and couples are forced to consider options few fertile individuals consider at all and even fewer undertake. As several of my respondent couples have observed, there are no more introspective and self-conscious decisionmakers than couples compelled to find the way to parenthood. Few fertile couples consider the meaning and value of parenthood and children more than couples who have to try to have children. Judith H. Lasker and Susan Borg ask whether those individuals unable to conceive or bear children of their own have been “designated … more virtuous, more selfless, more liberated” 44 than those who can? Extending their question, I wonder whether infertile women are supposed to become the prototypes for the truly emancipated and socially conscious woman? Should they be better able to extricate themselves from the structures in and strictures against which all women and men choose? Why is it that the “irrationality” and “obsession” of the desire to bear one’s own child, or to adopt a child who could have been one’s own, only emerge when the infertile woman or couple are described?

Unfortunately, on the shoulders of the infertile woman increasingly rest all the “slippery slope” arguments prognosticating what are perceived as the inevitably racist, sexist, and generally dystopian outcomes of continued advancements in conceptive technology. Maria Mies’s moral outrage against infertile women who seek technological solutions is clear when she proclaims that

any woman who is prepared to have a child manufactured for her by a fame-and money-greedy biotechnician must know that in this way she is not only fulfilling herself an individual, often egoistic wish to have a baby, but also surrendering yet another part of the autonomy of the female sex over childbearing to the technopatriarchs. Would it not be more beneficial to her to concern herself with telling other women, and possibly men too, about the causes of increasing infertility of men and women in the overdeveloped countries?

The infertile woman not only bears the burden of her infertility but also the burden of cruel and misplaced feminist reproach. Moreover, although critics may not intend moral arguments against conceptive techniques based on their unequal access to all women as arguments for their equitable distribution, the effect of these arguments is to link conceptive techniques to coercion and immorality in the case of the privileged infertile woman, but to authentic choice and fairness in the cases of the single, gay, or poor woman. Is any other woman but the privileged infertile wife considered to be “channeled” into reproducing and, therefore, into morally dubious technological solutions?

Finally, the plight of the infertile woman exposes the problematic place of motherhood in feminist thought. Feminist literature reemphasized women’s experiences of maternity as the basis for women’s empowerment and solidarity, the uniqueness of the maternal-fetal bond, and the mother-child relationship as the prototype for all human relationships. Some feminists are concerned that reproductive technologies, including prenatal diagnostic techniques, intrapartal monitoring, and cesarean section, are expropriating the natural and lived experience of maternity from women by transforming it into a technical, medical, and masculine event. If feminists, like their pronatalist counterparts, make childbearing and motherhood so central, why is the infertile woman suspected for wanting it? If motherhood is women’s entree into the feminine world of nurturance and relationship, infertile women’s efforts to enter this world ought to be understandable.

In a dialogue concerning in vitro fertilization, Barbara Menning, a defender of the new technologies and infertile herself, stated that she was “tired” of hearing criticisms of these technologies, especially by women (and men) who never have to consider using them. Ruth Hubbard, admitting a medically uneventful reproductive history, suggested that Menning’s claim to a woman’s right to have a child was little more than patriarchal brainwashing. Viewing infertile women who seek these technologies as “locked into subservience to the professional establishment” in a way that is antithetical to reproductive freedom for women, Hubbard suggested “strong, deep, feminist consciousness raising” as the more “therapeutic” alternative to the “technological fix.”

Beyond serving as a sign of women’s oppression, infertile women occupy no more important place in feminist than in medical and ethical discourse on reproductive technology. Significantly, as feminist critics themselves have noted, the needs and plight of the infertile are subordinated in medical and ethical discourse on reproductive technology to the eugenic possibilities of this technology; to men’s need to connect themselves more closely with procreation; to the potential desires of the fertile who might avail themselves of this technology in the future; and to concerns about the fate of the embryos, fetuses, and infants created by artificial means of reproduction. Yet the unique circumstances of the infertile are no more empathically presented in feminist discourse that also subordinates the interests of the infertile to the larger interests of women, the vast majority of whom will never experience the real devastation (no matter how unnecessary feminists might think that devastation is) integral to the inability to conceive or carry a child to term. When feminist critics argue that the infertile woman’s motivation for a child is not really her own, they deny her autonomous will. When they suggest that she ought to fulfill her desire for children by adopting, they ignore the complex problems involved in adopting any kind of child. When they suggest that the infertile woman might be happier remaining child-free, they contradict the emphasis many feminists have increasingly placed on the importance of “natural” maternity.

Sisterhood on the Fault Lines and Front Lines

My observations about infertility and the threat to female relationships are grounded in the recurring themes of female conflict expressed by women and from a concern about what women who care for and provide care to infertile women should be doing. Although insightful and appropriately cautionary, feminist theorizing about conceptive technologies does not adequately consider the concrete situation of the infertile women whom women caregivers face every day. As Sarah Franklin and Maureen McNeil suggest, feminist theorizing about reproductive technology must attend to individual women’s agency and relationship to this technology, in addition to the consequences of continued use of this technology for women as a social group. Such theorizing must avoid both biologically and socially deterministic conceptualizations of women that deny them authentic desire and autonomous choice.

As a nurse and as a feminist, I am especially concerned about the practical implications of feminist discourse on reproductive technologies for the compassionate care of women trying to have children. There is a persistent tension on the front lines of feminist action between the actually and potentially negative consequences of medical authority and technology for the health and well-being of women and the real benefits they can bestow. Nurses, who are in-between the physician and the patient, desire to humanize those medical rituals of diagnosis and treatment that these technologies entail, without, at the same time, acting as the physician’s “weapon and shield.” Yet what does it mean to be a sister, to care for another woman in an admittedly physician-dominated healthcare delivery hierarchy, when feminists often see the nurse as a mere proxy for the physician, even as a “token torturer” of women because of their so-called complicity in extending medical authority and implementing medical protocols. Is the nurse, like the infertile woman, by association with these techniques, guilty of undermining the advancement of women as a group?

What should the appropriate clinical response be to the woman who will do anything to have a child—telling her that she does not really want what she wants, that she ought not to demand technologies that have allowed some women like herself to become mothers because they threaten the greater well-being of all women, most of whom are fertile? If the ultimate purpose of feminist theory is action for the betterment of women’s condition, what action is demanded when a woman presents herself for medical treatment for infertility—a discussion of the pronatalist imperative, a consciousness-raising session on the true goals of patriarchal medicine, an invitation to consider the benefits of child-free living? How does the caregiver transform feminist insights and undeniably well-founded and well-documented warnings concerning new technological advancements for practical use?

Contemporary ethical codes for caregivers such as nurses and physicians emphasize their general obligation to take a patient’s desire to seek medical treatment as a given, to inform her truthfully of the potential and actual benefits and liabilities of her choice and of alternative choices, and to support her in the choice she ultimately makes, no matter how antithetical to their own personal (or feminist) sensibilities. Caregivers are also obliged to protect their patients from physical and emotional harm. Are women nurses, physicians, and other caregivers then contributing to the suffering of infertile women merely by participating in medical infertility services? What would the consequences be for infertile women of women caregivers refusing to participate in these services?

Future generations of women may be immune to pronatalist imperatives, but it is the infertile woman, here and now, who envies and feels threatened by childed women, who feels rage for women who terminate pregnancies and reluctantly mother, and who often feels the necessity to pursue the various solutions to infertility available to her. My respondent infertile couples do not construct the “alternatives” as the “pain, humiliation, and danger of in vitro fertilization” versus the “lowered self-esteem, devaluation, and loneliness of infertility.” For them, the critical sets of options are trying to have a baby versus trying to get one; becoming a parent versus remaining without children; and, most importantly, having regrets for not pursuing a particular option versus having no regrets, even though they might remain child-free. They see and carefully consider the opportunity and danger attendant to both medical and adoptive routes to parenthood.

The infertile woman, here and now, forces those of us who care for her to deal with a distinctively feminist moral dilemma: how to engage an individual woman’s concrete situation in its immediacy while engaging the condition of women as a social group. Feminists call for social rather than individual solutions to the problem that technological and other controversial solutions (such as surrogacy) for infertility pose for women and for feminist theory and action, but infertility itself is ultimately experienced individually. Accordingly, we must have a unifying framework for action that is neither insulting to nor open to misinterpretation by any particular group of women, an ethical framework that allows that choice and informed consent can and do take place but one that is nuanced to the concrete situations and the differing moral universe of individual women. The first social solution to the problem with no nice feminist answer is for feminists neither to minimize the painful reality of infertility nor to trivialize the desire to conceive and bear a child. We do not have to deny the infertile woman’s agency to be vigilant of the consequences for women of technological developments in reproduction. We do not have to question the infertile woman’s right to choose the solutions to infertility available to her to affirm any woman’s right to reproductive freedom. We do not have to suspect the infertile woman’s desire for a child of her “own” (genetically, gestationally), or a child who might have been her own, to celebrate the value of all children or to protect birth mothers from being forced to relinquish their children. We do have to make a comfortable place for her at the center of our passionate debates.